Influence of acid-base alterations on myocardial sensitivity to catecholamines

Hurtado, María C. Camilión de; Argel, María Isabel; Cingolani, Horacio E.

doi:10.1007/bf00503820

Cited by 23 publications

(5 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The escalating dosage requirements of catecholamines in septic shock could be attributed to impaired adrenergic receptor functionality in the presence of metabolic acidosis or overall desensitization of adrenergic receptors. [4][5][6] However, using large dosages of catecholamines is not inconsequential. Increased myocardial oxygen consumption and dysrhythmias are possible adverse effects of catecholamine infusions, especially at higher doses that may overstimulate the sympathetic nervous system.…”

mentioning

confidence: 99%

Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

et al. 2019

View full text Add to dashboard Cite

Shock syndromes are associated with unacceptably high rates of mortality in critically ill patients despite advances in therapeutic options. Vasodilatory shock is the most common type encountered in the intensive care unit. It is manifested by cardiovascular failure, peripheral vasodilatation, and arterial hypotension leading to tissue hypoperfusion and organ failure. Hemodynamic support is typically initiated with fluid resuscitation strategies and administration of adrenergic vasopressor agents in nonresponsive patients to restore arterial pressure with subsequent adequate organ reperfusion. Unfortunately, high catecholamine dosing requirements may be necessary to achieve targeted hemodynamic goals that may increase the risk of vasopressor‐induced adverse events. The purpose of this article is to review the clinical efficacy and safety data and potential role in therapy for catecholamine‐sparing agents in vasodilatory shock. Adjunctive therapeutic options to reduce vasoactive support requirements without compromising arterial pressure include arginine vasopressin and analogs, corticosteroids, midodrine, methylene blue, and angiotensin II. Although concomitant vasopressin and corticosteroids have a more defined role in evidence‐based guidelines for managing shock, clinicians may consider other potential catecholamine‐sparing agents.

show abstract

mentioning

confidence: 99%

Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Underlining this, Kohlhardt et al described already in the 1960s a significant, moderateacidosisinduced cardiac output decrease in nonfailing cats by 25% (pH = 7.00) (13). Further investigations on acidosis-induced decrease of myocardial contractility and its effect on catecholamine response were performed using different approaches and models (14)(15)(16)(17)(18)(19)(20)(21)(22); however, there still exist no experimental data describing the specific effect of metabolic acidosis in isolated ovine hearts even though sheep are widely used as animal models (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41).…”

mentioning

confidence: 99%

Influence of Mild Metabolic Acidosis on Cardiac Contractility and Isoprenaline Response in Isolated Ovine Myocardium

Schotola¹,

Sossalla²,

Rajab

et al. 2011

Artificial Organs

View full text Add to dashboard Cite

The postoperative course after major surgical procedures such as cardiothoracic operations is often accompanied by acute metabolic abnormalities due to large volume and temperature shifts. In general, those intervention-induced trauma might cause the use of catecholamines to stabilize hemodynamics. Within the cardiac community, there are still controversial discussions about standardized medical therapy to treat postoperative acidosis, for example, buffering versus nonbuffering for improving catecholaminergic response of myocardial contractility. The aim of this study was to investigate the influence of mild (and thus clinically relevant) acidosis on myocardial contractility and catecholamine response in explanted trabeculae of ovine hearts. Intact trabeculae (n = 24) were isolated from the right ventricle of healthy sheep hearts. Two different groups (group 1: pH = 7.40, n = 9 and group 2: pH = 7.20, n = 13) were investigated, and force amplitudes were measured at frequencies between 30 and 180 beats per minute and increasing catecholamine concentrations (isoprenaline 0-3 × 10(-6) mM). Force-frequency relation experiments in the presence of a physiological and/or mild acidotic pH solution showed no significant differences. Mean force amplitudes normalized to the lowest frequency showing no significant differences in force development between 0.5 and 3 Hz (n = 9 vs. 13, P = n.s.) (0.5 Hz absolute values 3.1 ± 2.6 for pH = 7.40 vs. 3.8 ± 2.6 mN/mm(2) for pH = 7.20, P = n.s.). Moreover, there was no significant difference in relaxation kinetics between the two groups. Furthermore, the experiments showed similar catecholamine responses in both groups. Force amplitudes normalized to baseline and maximum force showed no significant differences in force development between baseline and maximum isoprenaline concentrations (n = 6 vs. 9, P = n.s.) (baseline absolute values 4.3 ± 4.0 for pH = 7.40 vs. 3.9 ± 1.2 mN/mm(2) for pH = 7.20, P = n.s.). Additionally, relaxation kinetics did not show differences after catecholamine stimulation. The presented experiments revealed no significant negative inotropic effects on isometrically contracting ovine trabeculae with mild metabolic acidosis (pH = 7.2) compared with physiological pH (7.4). Additionally, similar catecholamine responses were seen in both groups. Further investigations (e.g., in vivo and/or in failing hearts with reduced compensatory reserves) will be necessary to examine optimal medical treatment for metabolic abnormalities after cardiac surgery.

show abstract

“…Klinische Zielsetzung eines Azidoseausgleiches darfnach therapeutischen Bemühungen, die Grunderkrankung zu therapierenniemals eine rechnerisch komplette Normalisierung des intra-oder extrazellulären p~-~e r t e > sein (2,8,10). Sollte ein Therapieversuch bei arteriellen pH-Werten kleiner als 7,l wirklich indiziert sein, so dürfen als initiale Dosierungen die Hälfte bzw.…”

Section: Risiken Bei üBerschießendem Azidoseausgleich Und Iatrogener unclassified

“…Sollte ein Therapieversuch bei arteriellen pH-Werten kleiner als 7,l wirklich indiziert sein, so dürfen als initiale Dosierungen die Hälfte bzw. ein Drittel der Menge des errechneten Defizits langsam verabreicht werden (2,8,10), da ein überschießender Azidoseausgleich und eine subsequent auftretende Alkalose, die für die Zelle wesentlich ungünstiger ist als eine leichte Azidose, vermieden werden müssen. Eine iatrogen ausgelöste Alkalose durch Überdosierung von Puffersubstanzen birgt neben den fur die einzelnen Puffer charakteristischen Nebenwirkungen als gefiirchtete Komplikationen einen kompensatorischen Abfall der Ventilation, eine neuromuskuläre Hyperirritabilität bis hin zur Tetanie aufgrund der Reduktion des ionisierten Kalziums, die Neigung zur Hypokaliämie mit allen Folgen wie kardialen Arrhythmien, die Gefahren einer zerebralen Vasokonstriktion und erhöhte Laktatproduktion.…”

Section: Risiken Bei üBerschießendem Azidoseausgleich Und Iatrogener unclassified

“…So kann Pufferung instabile Kreislaufverhältnisse stabilisieren und somit zumindest einen Zeitgewinn zur Behandlung einer Azidose zu Grunde liegenden Erkrankung schaffen. Ein vollständiger Azidoseausgleich ist dabei nicht erstrebenswert, pH-Werte >7,2 haben in der Regel keinen negativen Einfluß auf die kardiale Kontraktilität oder die Effektivität einer Katecholarnintherapie(3,6,9,10,16,19,21,22,29). Gazmuri RJ, von Planta M, Weil MH, Rackow EC: Cardiac effects Priv.-Doz.…”

unclassified

See 1 more Smart Citation

Azidoseausgleich: Pro und Kontra

Hörnchen¹,

Himmelseher²,

Pfenninger³

1994

Anästhesiol Intensivmed Notfallmed Schmerzther

View full text Add to dashboard Cite

New insights about the pathophysiology of acidosis as well as the efficacy of various buffer solutions have once again started the discussion about the necessity and indications of buffer therapy. After evaluation of the current literature one has to conclude that the spectrum of indications for application of buffer solution is remarkably small; some indications, however, remain well accepted. It has been shown that acidosis with pH-values above 7.2 has to be buffered only rarely, especially if the underlying disease responds to causal therapy. pH-values under 7.2, however, caused by renal tubular acidosis or by certain types of lactate acidosis, respond to buffer therapy. The choice of buffer solution depends on the pathophysiology of the underlying disease. In particular the application of CO2 generating buffer solutions under the conditions of critically reduced circulation and ventilation remains doubtful. Application of CO2 generating buffers seems to be justified only if intracellular acidosis can be prevented by immediate elimination of carbon dioxide generated by the buffer reaction.

show abstract

Influence of acid-base alterations on myocardial sensitivity to catecholamines

Cited by 23 publications

References 26 publications

Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

Influence of Mild Metabolic Acidosis on Cardiac Contractility and Isoprenaline Response in Isolated Ovine Myocardium

Azidoseausgleich: Pro und Kontra

Contact Info

Product

Resources

About